Over the past decade, we witnessed unprecedented advances in the field of biogerontology, and the massive convergence of biotechnology, information technology, AI, and medicine. And now we are witnessing the birth of a new field of longevity medicine, which integrates the latest advances in many of these fields of science and technology. My definition longevity medicine is advanced personalized preventative medicine powered by deep biomarkers of aging and longevity.
And, like in the field of AI for drug discovery, women are at the forefront of this revolution and there were precedents when we had to look for a male physician to make a conference panel more diverse.
One of the physician-scientists who stands out in this area is Dr. Evelyne Yehudit Bischof. I first got a note with a request for more information on one of our research papers from Dr. Bischof on December 30th, 2019 while in Shanghai. A request I almost ignored due to the heavy workload but accidentally I looked at her profile which was highly unusual. In brief, Evelyne is a German medical doctor with an MD from Max Planck Institute for Molecular Biology and Genetics, who interned at Columbia University, and Harvard MGH and Beth Israel Medical Deaconess, attending physician at University Hospital Basel in Switzerland, and associate professor at Shanghai University of Medicine and Health Sciences. She fluently spoke six languages including German, Russian, and Mandarin Chinese, which was quite impressive. The second time we met was at Human Longevity Inc, in San Diego when she was interviewing with one of the most influential entrepreneurs and investors in longevity biotechnology, Dr. Wei-Wu He to join HLI as a longevity physician.
The longevity industry is rapidly emerging and longevity clinics are being set up in various parts of the world. So I decided to ask Eva a few questions to elucidate this new and emerging industry.
Alex: Eva, we know each other for almost a year and you do not fail to impress with your academic publications, public lectures, and clinical work. You are as close to the “longevity physician” as it can possibly get. Can you tell us a bit more about yourself and about the work that you are doing on the clinical side and on the research side?
Dr. Evelyne Bischof: Thank you, Alex – it is an honor to be so generously introduced by a true innovator, scientist and entrepreneur, as well as a longevity KOL and allow me to revert the compliment. I am a rather globally oriented internal medicine specialist, with training and work experience in Germany, USA, Switzerland and China. For almost a decade now, I have been splitting my time between Shanghai and Basel, creating a path that allowed me to conclude my residency and fellowship, develop translational and clinical research niches and collaborators, as well as to engage actively in academic medical education. While my clinical work was mostly based in a university clinic in Basel in internal, intensive and onco-hematologic medicine wards, my scientific pursuits and academic teaching were mostly based in Shanghai, where I went along the track from a junior lecturer to an associate professor in 2016. My research focused primarily, but not exclusively, on oncology and – being an internist at core – on geroncology and precision medicine in general internal medicine. Geroncology is a crucial field that investigates the very much interlinked pathways of aging and tumorigenesis, leading to the epidemiological observation that age is the number one risk factor to develop cancer – for all.
Both Switzerland and China are innovative hubs with strong medical and bioscientific profile, which allowed me to learn from some of the finest experts worldwide. The frequent travels and splitting my life between continents were not always easy, but – coming from a simple background of non-academic farmer and handcraft family Alongside – I will be forever grateful for all the great people I met and worked with, the abundant cultural nuances and differences I was able to learn and appreciate, the stimulating and constructive exchange and so much more in soft and hard skills, on professional and personal level. with the emergence of AI-based solutions in the clinic and with the rise of longevity medicine, my passion and efforts are now focused on these domains, while I continue my clinical practice in the university hospitals, academic lecturing at two medical schools (currently in Shanghai – due to COVID-19-related travel restrictions) and research/public speaking (globally – thanks to COVID-19-related shift to virtual communication).
Alex: Can you tell us about your perspective on the emerging field of longevity medicine starting from your own definition of the field?
Dr. Evelyne Bischof: With pleasure! My personal definition of longevity medicine is clear: it is precision medicine driven by deep aging biomarkers. Surely, the definition is succinct, but extremely deep. Precision medicine is per se an enormously complex and dynamic field, driven by multimodally mined data and their constant re-evaluation, reannotation and reiteration to provide qualitative and quantitative using AI-algorithm outputs applicable for clinical practice. Longevity medicine is a to say the next generation of precision medicine that evaluates the patient within the reference range for the patient’s ideal age (usually 20-30) and is looking for ways to reduce the gap between the current parameters and the parameters of maximum physical performance for the ideal age. Deep aging clocks as quantifiable, trackable and accurate biomarkers of aging – and an indispensable component of longevity medicine. Without being able to actually measure the biological age and its changes due to interventions, longevity medicine cannot be performed. I strongly believe that this field of medicine will revolutionize healthcare and change the mindset of all – the doctors, the policy makers, the stakeholders and above all: the patients. Allow me to add that I consider each of us as a patient – we all suffer from aging! I also believe that – citing Peter Diamandis – in the future, “if a physician won’t be using A.I. in guiding diagnosis and therapy, it’ll be a malpractice”. This said, I would love to add that we need more passionate physicians in longevity and this can only be achieved with an appropriate educational setting, which will be inaugurated this month by Deep Longevity and collaborators.
Alex: What do you see as the most promising developments in the field of longevity medicine that can truly push the needle and add a few decades if not more to the healthy youthful life of the individual?
Dr. Evelyne Bischof: Besides of deep aging clocks and AgeMetrics, which I truly – without cronyism – embrace and would encourage all physicians to implement in their daily practice, I see a big potential in gene therapies, in (natural and designed) gerolytics and senolytics, as well as supplements that will show safe efficacy in combating senescence from the molecular to system level. Studies on AKG, rapamycin and metformin are already fueling this hope. Of course, all interventions will require a prior comprehensive precision health assessment and continuous monitoring. For the latter, the wearables and applications will certainly bring us even faster to an extension of a healthy and productive lifespan.
I am encouraged by the fact that there are two major developments, perpetuated by the racing speed of longevity medicine and geroscience. Number one: doctors are shifting from putting a patient on meds to putting a patient on a personalized longevity protocol that becomes a natural, integral, rewarding part of their lives. Number two: society is realizing that it is not important how old one is, but how one shows his/her own age. Remembering this allows one to make sure he or she does not become a slave of the myths about the elderly, but also to be mindful that even at an early chronological age, one might actually experience silent accelerating aging due to modifiable risk factors or pathomechanisms.
Alex: Without promoting Human Longevity Inc or Health Nucleus 100+, can you tell us what an average person with an average income can do to increase their performance and longevity?
Dr. Evelyne Bischof: This is a very valid question – in fact, when it comes to reasonably boosting performance and creating a good base for longevity, one does not necessarily be wealthy. The components of the “magic mixture” are the well-known pillars of preventative and functional medicine: exercise, nutrition, supplements, moderation. However, longevity physicians are now able to customize the right proportions of each for a specific person, minding the biovariability, comorbidities, chronological age, but also lifestyle and preferences. In an extreme generalization, I would suggest caloric restriction via intermittent fasting to an overall healthy person, with at least an A-Z vitamin and mineral supplement, 15-30min workout at least 3 times a week, moderation in substance use to the minimum, but with permissible enjoyment, if needed (alcohol and cigarettes), a minimum of 6 hours of sleep without interruption, circadian rhythm (regular times) of sleep and food intake, no meals at night (at least 4 hours before night rest) and very importantly – cognitive activities (books, foreign languages, crosswords), preferably rewarding ones so that the psychological wellbeing area is also covered. Everyone is able to use stairs as their gym, to not to eat before sleep, to choose water over other drinks, to laugh aloud to oneself and to learn text parts by heart (because decelerating psychological aging and cognitive decline are crucial aspects of healthy longevity). I recall I was always reading the ingredients and “how to use?” texts on tubes during shower, so as not to waste the time. My first sentence in Russian was actually the instruction of how to use a shampoo.
Alex: And if someone has nearly unlimited access to capital, what should they do?
Dr. Evelyne Bischof: I believe, as in any other business or property of this particular population, the individuals should seek good investments and insurance in relation to their health and the health of their significant surrounding (family, friends, workers etc.). The “investment” should involve as precise diagnostics as possible, that harnesses all cutting edge and untapped potential of the human genome, deep quantitative phenotyping, complete -omics and -ioms (e.g. microbiome, epigenomics, metabolomics, proteomics etc.), advanced imaging with radiogenomic algorithms etc. As it is a dynamic field, constantly evolving and implementing new features and/or better ways of interpretation, such diagnostic comprehensive checkups (or part of them) should be repeated regularly. The “insurance” part does not relate to a contracted policy, but to a complex entity of lifestyle recommendations and interventions lead by an entrusted longevity physician (basically a physician that can list and pronounce the aforementioned terms), who understands and permanently advances in the field, being able to combine human and artificial intelligence and customize an individual approach of prevention and (if needed) therapy for a specific patient. In addition, the leading physician needs to comprehend and implement the personal challenges and preferences of the patient, such as mostly disturbed wake-sleep rhythm, irregular and unhealthy “social” meals, acute and chronic stress exposure, irritability or fatigue etc., to create a program that will be realistic, allow the patient to remain compliant and engaged based on his/her educated informed decisions. Simply said: knowing 150 GB of a patient’s data, a physician of trust should be a good lead towards identification, mitigation and elimination of actionable diseases (years and decades ahead) and risk factors that curb the quantity and quality of life.
Alex: I know maybe 3-4 people like you in the world, who have an MD, are actively engaged in biomedical research, and work with some of the high-profile clients who are spoiled with the most cutting-edge medical care provided by the top medical institutions. And all of them are women. Why do we see such gender imbalance in the field?
Dr. Evelyne Bischof: Again – thank you very much for this encouraging statement, this time speaking on behalf of women in medicine, academia and STEM. As you know, one of my “side” areas of interest is the study of biological sex differences in various diseases, predominantly cancer, and ultimately also on the sex (biological) and gender (socio-cultural) variables influencing pathomechanisms, diagnostic and therapeutic decisions, resulting differing toxicities, follow up strategies and outcomes (recovery, chronification etc.). It was natural to engage in debates and develop curiosity about the gender distribution in academia in general. Recently, with an ad hoc group of collaborators from Europe, USA and China, we demonstrated in a Lancet Oncology paper that female representation “at the podium”, meaning as keynote speakers and scientific committees at the largest oncological conferences in China. Our data showed that China is much more inclusive, without an intensive active promotion or directives towards gender quotas. As you know, I am a big fan of this country, but this quantitative study once again showed how impressive this country is – and perhaps we found one of the contributing factors for the nation’s booming leading role in biotech and medicine.
Overall however, there are indeed significant differences in various fields, as well as an overall underrepresentation of females in leadership and podium roles. I am happy to see that in longevity science and medicine, we have dedicated females that can unfold their passions and translate them into viable solutions that do impact the public and individual health. As always, the reasons are multifold, but perhaps the most important one is that in longevity, driven women are emerging in an inclusive environment that embraces non-discriminating and non-stigmatized diversion. In different words: the longevity field seems to embrace inclusion at the same (ultrarapid) pace as STEM and medicine are evolving. The sex and gender differences clearly allow to generate creativity and innovation – it is a mutually perpetuating process. Last but not least, it is thanks to committed male mentors and collaborators that actually value D&I (diversity and inclusion) – intuitively or knowingly (based on evidence that diverse teams outperform the less diverse one by over 35%). Most male KOLs in longevity, like yourself, promote and underline the importance of D&I. On a final note – myself, personally, I have always remained at the unconscious side when facing a person I work with. Accountability, motivation and fairness have proven to be non-gender related in my experience as I have faced many challenges being a (previously young) female, permanent foreigner and on top of that – blond. The typical situation at a round dinner table in China with 12 male professors usually ended up with us all laughing at my “gambei” with water being the only discrepancy from the “norm”.